 This is Donna Prosser. I am the Chief Clinical Officer here at the Patient Safety Movement Foundation, and we're really excited to be joined again by our friend, Dr. Ed Kelly, with the World Health Organization to give us an update on what's happening with the pandemic. Ed, are you there? Yes, I'm here. Wonderful, wonderful. Nice to see you, Ed. Nice to see you too. All right, so I think, I know we have a lot to get to today, so let's go ahead and jump on and get started. Good, thanks so much, Donna. And, you know, I'm adopting with, you know, a significant paperwork was involved, but an appropriate California kind of look for today's briefing, if that's okay, with my formal virtual background here, but at a nod to Patient Safety Movement Foundation and everybody in the US. And also summertime, it's warm here, very warm here in Geneva, which for Geneva is like, you know, in the low 80s, so everyone's going around fanning themselves. But so I'd like to, with thanks again for the Foundation for having us back, I'd like to go through a bit of an update. You know, we use these periodic connect points as a chance to update Foundation and colleagues on where we are globally on the outbreak. And also what are some of the things we're seeing and some of the work that we're doing. And it's also an opportunity for us to, if not in the Q&A session, but afterwards to connect with folks who may have ideas or input for us. And I think there are a couple of areas that I would really like to get feedback during the Q&A session or afterwards. And it's also, we're undertaking this during a time when our team, the patient safety team is working full steam on World Patient Safety Day, which comes in September. And also on the global action plan on patient safety, which Member States asked us to produce in time for next year's World Health Assembly in person or not in person that'll be produced. And so, you know, right now we find ourselves probably in the midst of the biggest global incident in patient safety ever. And so I think this is an opportunity but also very overwhelming. So maybe I can go to the next or my first slide. Next, Dr. Tedros has really flagged the idea that minimizing healthcare disruptions caused by COVID-19 is gonna be the key to managing the overall impact of this outbreak, morbidity and mortality. And I think that the ability of health systems and health services to keep essential services up and running is a real canary in the coal mine for the wider issues that societies face as they try to maintain either open up post lockdowns and maintain essential services and their economies. So I think this is, it's of highest importance. And next slide, what I'd like to do is just give us a quick update and then run through a few items that we've been working on in terms of assessments and guidance, but also to flag for some of the attendees today this global collaboration that exists, the ACT Accelerator, which is Access to COVID Tools Accelerator and the health systems work there given where patient safety and the rest of the essential health services sit in that. And then I just finished with a picture of what countries are doing or in some cases not doing unfortunately in terms of responding to COVID. Next slide. So just in terms of the global EPI situation, this, I won't spend too much time on it, but it gives you a picture of the cases we've seen. This is just as of today, our report out. It does not have the United States numbers in it. We, for the past three weeks have had a strange anomaly we were doing this on Tuesday, we would have all the numbers, but an anomaly over the weekend that CDC reports too late for us to have it in our morning numbers that have to go out in time for the waking up Western Pacific, but I'm sure they'll come back. But the, you know, there's 200,000 new cases in the last 24 hours. I'm sure it'll be a lot higher. We hit our biggest day ever just the day before yesterday since the start of the outbreak. We've now crossed into the 15 million cases for reference, it took us five days to go from 14 million to 15 million cases to go from 1 million to 2 million cases, it took 93 days. So anyway, still a lot of numbers there to look at. Next slide, please. This gives you the numbers, but week by week, and you can see last week was our biggest week since the start. You don't have to be an epi expert or stats expert to see we are not headed in the right direction, either in terms of cases or in terms of deaths that both have ticked up recently in a sizable way. In terms of the statistics by region on the next slide, you can see it gives a picture of sort of the shape of the curve and case fatality rates. The cases are in the bar charts and that line is the death rates. You can see in our Africa region, our Pan America region just below it, and in the Southeast Asia region, all classic epi explosion curves, just really upward curve headed way up. In the Eastern Mediterranean, they've seen some dipping of the curve and you can see in the Western Pacific, there's what's clear as a second wave come. We've had issues in Hong Kong and elsewhere that cases in long-term care facilities, a topic that I'll come back to. And you can also even see in Euro that little blip at the back, things were dipping lower and it's ticked upwards. As I was talking with US based family over the weekend, they're saying, oh, he's so lucky to live in France and Switzerland. And I do think that they're, you know, the numbers vary greatly around the world, but both France and Switzerland, for example, as two countries who did a relatively good job at managing the case numbers have both seen an upward tick. But just in comparison, if you look at per 100,000 population, the last about four weeks, France went from 2.8 to 3.8 to 4.4 to 6.8, so gradual increase. Switzerland went from 2.4 to 7.2 to 8.1 and then 8.6. In that same period, unfortunately, the US went from 73 per 100,000. So approximately 35 times what France was, to 96, to 136, to 141 per 100,000 for the same time period. So anyway, everyone can work on things that some of us maybe can be working a little harder than others. Next slide. So I mean, I think one of the issues that we have really tried to wrestle with is this getting a handle on how, quote unquote, disrupted our essential services. We've done some work looking at the pandemic across 25 different essential health service lines. And the survey closed at the beginning of the month, we've still gotten a few countries giving us more information. This gives a little bit of the background on it. And then the next slide, here we try to summarize a few of the bullet points. Basically, most countries have taken steps to identify a core set of essential services. So these are the things we are gonna try to really keep offering during the outbreak. And then other stuff we're going to put on hold, voluntary surgeries, in some cases dental services like non-essential dental care, et cetera. But the issue is that on both sides, even though most countries have defined those services, only about half of those country governments have provided any additional funding. And if you look across the service provision areas worldwide, about half of essential services across the world are disrupted in some way. And obviously disrupting assisted deliveries has a much bigger impact than disrupting, perhaps rehab care, but still it's a big impact across many services, even all the way down to emergency services being disrupted. And down at the bottom, we show some of the issues that countries flag, it is about personal protective equipment, and but it's also about capacity and having the appropriate staff that are available to surge and having the right guidance and understanding about best practices. Next slide please. So one of the, we've obviously got the response work that's ongoing by WHO and by partners for the COVID response. Earlier this year, the director general together with other partners launched the ACT accelerator, the Access to COVID Tools accelerator that brought in collaborations with the World Bank, with Gavi, the Global Alliance for Vaccines Initiative, the Global Fund to address HIV-TB malaria, and other global players in global health to try and come with a joined up approach on getting vaccines, therapeutics, and diagnostics into the hands of frontline providers. And obviously for anyone who's had the experience of whether it be the HIV pandemic or even the introduction of things like the rotavirus vaccine or others, the idea that you develop a great vaccine, the chemical vaccine is a long way from actually getting everyone in the world vaccinated. And there's a big estimates, for instance, that some of these early vaccines you'll need two doses that means anywhere from sort of seven to 15 billion doses. Vaccinations need to happen around the world. And we've still got a long way, I think was explaining in a previous session to even getting some of the basics like measles vaccines to all children around the world. So that was why this health system strengthening Crosscut was put in as a foundation there to look at what are some of the foundational elements that need to be there to make sure that these new tools sort of fall on a well-fertilized ground. The next slide, the areas that we're working on across the different partners, UNICEF and other UN partners as well as like I mentioned, World Bank, Gavi Global Fund include issues of readiness at the country level, financing, engaging in the private sector, how we mobilize the health workforce, what is the response in communities and how can we engender more community-led leadership to key areas of integrated data and clinical care, which I'll come back to, and then work on the supply chain that's for all the other essential supplies that are needed to keep essential services running for this. So this particular piece of work is gonna be really key as we head into later this year and next year with some of the, we've had some of the therapeutics already coming, dexamethasone and other therapeutics coming online, but there'll be a whole host of them soon and we'll need to be ready for it. So on the next slide, one of the areas we've been tracking was to come with a more integrated data approach. One of the things for those of you who've worked in global health and those who've worked in public health, even in the US, your average frontline provider, whether it be physician, nurse, community health worker, spends a ton of time gathering data rather than seeing patients and whether that be for insurance companies, whether it be for state public health agencies or national agencies or even global efforts. What we were trying to do here, given that all countries around the world, decision makers and providers are just running to try and keep up with this virus, even in countries that have relatively low caseloads, was to come with an integrated approach on the data collection. Next slide. So we also tried to come with an integrated approach on the clinical care work and this is particularly relevant for some of the clinicians on the seminar today. One of the difficulties we've heard from, whether it be in the US or in South Africa, patients are presenting without a diagnosis, they generally present without a diagnosis often. They may or may not have COVID, they may have very unspecific symptoms. They, if you're in a malaria endemic region, having a fever doesn't mean a lot of different things. We're heading into Southern Hemisphere, we already have the flu season, we'll head into that in the fall. So that'll be a big complicating factor in terms of syndromic diagnosis. So the key processes of screening, isolation, triage, monitoring and targeted referral really have to be in place as things come back this coming fall. And this particular work stream was really designed to help support countries and local decision makers on how to provide integrated clinical input and then how we can support some of the integration of clinical processes. Now, for me, it's a great indication again of how this virus doesn't do anything except shine the light on gaps we've had in the past. I worked for years at the Agency for Healthcare Research and Quality based in Bethesda then Rockville, Maryland. We used to study how long did it take even when CMS had a reimbursement plan or had a national quality improvement effort either at the hospital level or in nursing homes, how long it would take for quality standards, good practice to get disseminated through the system. And it is anywhere from two to seven years sometimes would recommended clinical practice take to really make it into general practice. And these types of time frames are really not what we have time for in this particular environment. And so how we can get out to frontline providers, recommendations about for instance, DEXA and OxyCin in a rapid fashion is something we've never done before. If you talk about having, you know, putting out an RNA virus which has never been done before and the time we're talking about which has also never been done before. I think we're also overlooking the fact that we're gonna have big, just amazing changes in clinical practice for acute respiratory illness that are gonna have to be supported in some ways. And there's no way your average position is gonna be able to follow all of the different recommendations, the gazillion articles that are out there and all the claims sometimes spurious around different products. So I think that's one of the things we're hoping to be able to sift through and provide some better information. And nowhere is it a tougher clinical management scenario than in long-term care. Then the next slide we come to, we've just finished a guidance on a policy brief on long-term care facilities to look at how to prevent transmission and reduced mortality. It's really focused on the sort of issues of how at the policy level and was a subject of a long review by many different experts and that's just gone up on our website over the weekend. The on the next slide, the main objectives were really to provide some of this policy guidance and key action points. As people know, and we've talked about here, long-term care in almost every single member state of WHO if it exists is highly fractured. Usually is very heavily dependent on private sector provision, meaning the sort of basic standards can be very variable. The how patients enter or leave long-term care can be through multiple channels, primary care, emergency care. They may come through a retirement facility. So there's all sorts of issues and the staff tend to be come from, tend to be from many different places and also not just work in one given long-term care facility, all of which is an IPC nightmare. So these are some of the guidance points and 11 policy objectives on the next slide sort of lay out some of the key issues that we've put in detail in the guide. And we're just now working on an operational guide that's going to boil down some of the care provision elements of this, which is particularly in the seven, eight, nine recommendation areas. And also summarize our IPC guidance and our clinical management of COVID for elderly and long-term care patients. So that'll be coming shortly. And at least we're hoping that this provides some basis for national policymakers to be looking at their long-term care and making needed changes, which should be done anyway, but COVID once again gives us the immediate impetus to move quickly on it. And I'll just finish before we get to some of the Q&A with some thoughts about what countries are doing or not doing. So all countries globally have been asked to consider putting together a national response plan for COVID. Most countries have such a plan, WHO, we reviewed all those plans are also provided to WHO and they are in general map to our nine pillars of our strategic preparedness and response plan for COVID. And we looked at them in particular with trying to understand how well were countries planning, how well have they funded their work. And on the next slide, the idea was really to see, is there alignment between these country plans, which are CPRPs with the global plan, which is the SPRP and then also countries that qualify as humanitarian response countries, the countries like Yemen or Iraq, but there's many countries, there's in the, I think there's 28 photo globally. So the global humanitarian response plan, the GHRP lays those out as well. And we looked at those countries too and were they also trying to address these issues. So we looked at the inclusion of essential services there, the quality aspects and were they well-costed. So some of the findings on this, I'm very happy to provide this in more detail if people on the call are interested in particular countries or interested in the methodology. But on the next slide, some of the key messages, laid out show that the alignment across all of the pillars and then across the topic areas for the global humanitarian response plan is really quite varied, unfortunately. And there are countries who even not only, the gap is not necessarily that they don't have any plan, although that's a few countries, but some of them even have multiple plans up to four separate plans for COVID, which also can be as damaging as not having any plan at all if you have total confusion over who's doing what. There's a definite room for improving the consideration of a central health services in these plans. Many of them deal with the issue of infection prevention and control, something we've talked about a lot in these sessions. But only 12% of the plans have a designated person responsible for health services or the health services resilient, so if you don't have anyone responsible for it, it will definitely not get done. So in the entire country, you need at least one person who's looking at maintaining essential services as an important piece of work and only 12% of countries have really specifically allocated funding for this. So I'll just finish there, Donna, with this idea that we clearly have, again, the something of, if you look at the Western Pacific, if you look at Europe, which is not quite as far along, we are going to have this something of an accordion situation where countries start to work on opening up and cases will go up. There's no question. And then you'll have to perhaps ratchet back down. And the whole point is to not have this explosion and closure and explosion and closure. And I think this sort of assessment, two points, when we had a discussion with business leaders on Friday about, with questions about, when will the pandemic end and what will happen next, Mike Ryan, who's the head of the emergencies program. And I've both said, if we could predict when it was gonna end, we definitely would not be sitting in these chairs where we were. But the whole point is that our word was the virus will stop. This outbreak will stop when we make it stop. So we have shown very clearly, very clearly in a bunch of countries that public health measures can control the virus. We can control the virus. So if we don't control it, then it controls us, that's for sure. And it's quite clear that we are going to need the work on the vaccine to continue, that that's gonna be something going into next year. There's a lot of discussion around things like a global glass shortage for piles and concerns about countries buying up supplies for that. That is, I think, a concern. That's precisely why the Act Accelerator was put together to get a more equitable allotment and allocation approach going. But whether that's going to stick or not, I personally have my own, I'll actually put it, skepticism that all countries will just be willing to play by the rules. So this is why I think it's really important that we show that the strategies that countries can have on detection, on testing and detection, on case finding, using public health measures, the full lockdowns are very effective, but very blunt tools that cause a lot of damage elsewhere. And I think that that's one of the messages that we've had from the Director General, both today and the press conference that just happened as well as on last week, that the tools are in countries' hands and we're working as hard as we can to try and get the vaccine and that work forward. But the approach I think we're in for a long haul in terms of looking at some of these potential solutions, which is why this issue of safe provision of healthcare has got to be really front of mind, again, as this canary and a coal mine for how countries can really progress and keep their economies open. So why don't I pause there, Don, and we can take some questions that are very happy to share in the chat or offline, some of the documents that are referred to. That would be great, thank you so much. We do have a couple of questions. The first question is related to testing. Now, there's been a lot of questions about the validity of the tests. So for example, if here in the United States, some people are finding that if somebody tests for COVID more than once, it counts as multiple positive results. Is that an issue? Is there a concern about, or should we be concerned about the way that we are calculating tests worldwide? It is something we've talked about here, like that some people testing positive more than once for coronavirus. I mean, it basically doesn't mean that necessarily that you've been reinfected, but it can mean that there has been some idea that very weak immune, if you've had a very weak reaction to the virus that you can be reinfected. But I mean, we've had, and also my colleague, Maria Van Kerkhoff has talked at the press conference even just recently that doctors have been finding instances where dead cells that emerged during the healing process of lungs were testing positive for COVID, but it didn't necessarily mean that the individuals were reinfected. So whether from our standpoint, we have not seen any evidence that that's having a big impact on numbers, on global numbers. We have been looking, and I'm happy to show this offline, doing some deep dives on testing approaches and testing rates across countries. And I think one of the things that, anyway, I wish more countries, U.S. included, had these types of track this type of information about how much testing they were doing, but then how quickly they were following up tests with calls to potential contacts, these types of issues. But the idea that the test positivity rate, I think is a better indication of whether you're getting extra noise in your numbers. And most countries, many, many countries are seeing their test positivity rate still very high, which means you're still only testing probably very sick people. You need to be testing many, many more people. Great. Question about the evidence that you're sharing with everyone. The question is, how do you decide when the evidence is strong enough so that you can convey a certain degree of, well, just to convey the certainty that you have? Yeah. The WHO's process for evidence reviews, and it'll depend anything that's a guideline process. We've sped up immensely in terms of our production, but there is a guideline development committee that's put together of external experts. All those experts are vetted for outside declaration of interests and also whether they meet standards of objectivity and expertise. And then the evidence is compiled, sometimes is usually compiled by a methodologist and a systematic review is conducted. So that has to meet a certain standard of the scope and size. Then the evidence and the recommendations on the, are actually reviewed by the Guidelines Development Committee and a final guideline put forward. So that's the standard, roughly the standard process. And we have the Guidelines Development Group, which is an internal set of experts that review this. And then under COVID we have a third control, which is the Publications Review Committee, which is led by the editor of the bulletin of the WHO and has a set of external and regional experts, technical staff who review all of the publications to make sure that they are in alignment with the existing evidence. So anyway, if that sounds very onerous, it is, but that's WHO's process for putting those together. And the idea is that if you do the right things, then on the other end, you're gonna have robust, as robust a picture of the evidence as possible. But with this outbreak has really challenged us because stuff happened so fast and it's a novel virus. So that meaning it's new. So we've had to look at other light viruses, other flu light viruses and other things. And there's plenty of areas where we've said, look, from what the evidence says, I would say take masks. This is what we think we can say now. We may change it down the road. We have, let's see, in March, we said one thing in June, we've expanded to say some of the evidence suggests that in constrained environments, that it could be a good idea to wear masks. So I think we'll see a lot of changes over the next year or two, especially within the therapeutic areas as we see new therapeutics coming online. Great. Ed, we are at 7.30, but I have a few more questions. Do you have just a few more minutes? Maybe we can get a few more in. Yeah, yeah, yeah, no problem. Okay, great. So question from Helen Hughes. She wants to know, what can we do to speed up the provision of the guidance to the frontline? You talked about how it takes two to seven years to get it out there to change practice, but what can we do to speed things up in this scenario? Yeah, well, I should be asking Helen that, but anyway, that's a great question. She said, anyway, it has a lot of expertise in this. I think that's been one of the big challenges, and I mentioned that earlier about even in the U.S. and in traditional, anyway, clinical care, you tend to sort of do what you learned at med school, and then sort of that's, it's tough to change those practices, but I think we have a real opportunity now, and this is the interface we talked about a long time ago with digital health for really leapfrogging in some ways, some of this provision of information, just because literally every single clinician in the world, practically, is like so tuned into this COVID work because they have to be, that it provides an opportunity for setting up platforms for rapidly getting out some of these new data on new diagnostics or on what are the risk factors, is obesity a big risk factor or not? Are we seeing higher rates in certain ethnicities or not? And everyone's just so attuned right now that I think we have an opportunity that we wouldn't normally have. There's not such a, at least from what I've seen, there hasn't been such a focus on this and a coming together on this. There's been a lot of focus on data platforms and sort of supply chain platforms, but not so much on like knowledge platforms. So I think this would be, anyway, it's a good area for maybe the foundation and some of the colleagues around the world to get into. Great. We'll take you up on that. Good. Question about long COVID. This is a new phenomenon, it seems, that we're hearing about people who have, who are experiencing COVID symptoms for months at a time. Is the World Health Organization doing any research on that or have any guidance? Yeah, we have looked, we started to look a little bit more at, you know, what is the sort of that syndrome and what does it mean? You know, there's been a couple of really good articles recently on this. BMJs had something, others bad things that, but WHO hasn't put anything out on it. We've looked at it from a rehab perspective and, you know, in terms of, you know, what does it mean? And it doesn't, at the moment, there's not so much evidence on, you know, the certain types of patients tend to present with this or are they more likely to get this? There's, for a while, there was a discussion around or certain blood types seem to be harder hit than others where it really sort of drags out. But I think what I'd seen from the BMJ article was that the Royal College of General Practitioners had mentioned to their GPs and other colleagues that they should expect, you know, certain influx of patients with long COVID. And I think that it'll mean that it's both, and I think we should be thinking about both the physical and sort of emotional and psychological impact that it can have, that it just really takes people, certain patients, a really, really long time to come out of this. But this, again, is one of those possibilities where new therapeutics will eventually have some kind of impact. But I would expect us to do something on this within the next few weeks. Great. Another question was related to the vaccines. Do you have any idea how the vaccines are produced? Are they cell based? I know you talked about an RNA vaccine. There's probably several different kinds, but it had some questions about how they're produced. Yeah. For me, I am not personally a vaccine expert, but we have a ton of those at the organization. A bunch of the leading candidates are RNA vaccines that are out there. You know, we now have four or five that are in, headed into phase three trials. And the fact that we've come that quick along this, I think, is pretty amazing. I think also there's been a lot of talk about, oh, are we cutting corners on safety and these types of issues? There's been a couple of really good interviews with some of the lead folks for the vaccines. Great one with colleagues at Oxford about the fact that actually technically, if there was sort of semi-unlimited funding and global attention, any vaccine could potentially be produced at this fast. It's just that in the typical process, it takes much longer. The regulatory agencies don't run parallel checks on things and this kind of stuff. So the main message is that the process is the same as it will be for any vaccine that's been produced up till now. It's just that the global attention and funding has meant we've been able to speed things up astronomically. So whether that, anyway, it's still, we've never, as people know, there's never been an RNA vaccine that's been delivered to market. So that's a, anyway, that's a little bit of a daunting element, but I think the fact that there's so much attention on this means this is gonna be one of the first ones. Great. And then a question about the spread of COVID, a lot of folks have been locked down in their homes for some time, but they're still very concerned about being able to catch the virus. So can you just talk a little bit for folks who are staying at home, what is their risk for catching COVID when they are following all of the recommendations? Yeah, it's very, I mean, it really depends on what your community situation is. If we still talk about, in terms of the epi situation of having isolated cases, sort of to clusters of cases to community spread, and many countries sort of slid between those. And the bottom line is that if your community does not have sort of widespread and really high numbers, then if you do the right things in terms of, when you go out, you practice really good hand hygiene, if you're in crowded, you have to be in crowded space, bringing a mask with you, certain of the most communities, many communities now have requirements on wearing masks. And that you are able to isolate yourself appropriately, the risk can be really manageable. I think of course, anyway, it's gonna be a bit of a marathon, as we've seen, we'll be into next year most likely, that we'll have some kind of, having to be thinking about this. And I think probably we should be thinking about this, is just, this is gonna be the way that probably a sort of cleaner, healthier me is going to live in the world and that I'm really gonna cut down on my winter colds and any sort of stomach bugs that I get and this kind of stuff, because I'm gonna be much more careful about infections and that kind of thing. Now, whether or not the French will give up the kissing on two cheeks permanently is really gonna be tough to say. So I think there are certain practices that will die hard, but I think your average person can really do a lot in terms of taking care of themselves. And anyway, by the way, that means not just like preventing the infections and staying home, it also means really taking care of yourself mentally, because I know a lot of colleagues who either, they're single, they live on their own, they're teleworking and it can be very difficult. So finding ways to get out, see friends safely in an innovative way that's really important. Great. Well, Ed, as always, you have brought us some fabulous information. We thank you so very much. And looking forward to having you back again, I hope, soon. Yeah, good. Well, let's play it on and we'll definitely come back to some of the documents that I shared. And it was great to see some of the people who are on here and thanks particularly to John for some of the references to some great, very good references that people should definitely read. So if you haven't followed the chat, please do. Excellent, and Kaylee will make sure that we have all of those links on our website when we post the video. Okay, good, thanks so much. Great, thank you very much, Ed. Have a wonderful day. Goodbye, everybody. Have a great day.